Implementing ICD-10 in PayDC/APS (October 1, 2015)

Content from this handout is derived from the ICD-10 Overview Webinar given by David

Klein on September 15, 2015, and available on our website, paydc.com, under Resources,

Recorded webinars here. This handout is greatly abbreviated, so please consult the webinar

and available books and documentation for complete information.

Background and changes (0:00 – 26:30)

Make sure you understand ICD-10 and have a coding book.

10/1 is date of service, not date of claim submission

Worker’s comp and auto insurance payers do not have to switch (not HIPAA-covered).

Some states are mandating that they switch; it’s also payer’s choice. So need to find

out from payer.

Finding an ICD-10 code:

1) Go to GEMS (general equivalency mapping) from Medicare

2) Alphabetic index

3) Always confirm the code using the tabular list (includes rules and information

you need to know)

Make sure you understand Includes, Excludes1 and Excludes2

Bilaterality: If a condition is bilateral and there is no bilateral code, you have to list

the left and right separately

Understand use of 7th character for initial encounter/active treatment (A),

subsequent encounter/routine care during healing or recovery (D), and

sequela/complications or conditions that arise as a direct result of a condition (S)

CMS-1500 claim form – understand the 02/12 revisions

Implementing ICD-10 in your practice (26:30 – 51:15)

Step 1: Set up appropriate ICD-10 codes to correspond to the ICD-9 codes your

practice uses

Step 2: Validate your equivalents with a test patient record

Step 3: Create ICD-10 versions of your care plans templates and test using your test

patient record

Step 4: If your practice uses the Billing module, update Insurance Carriers to ICD-10

as appropriate

If you follow these steps, then converting patients to ICD-10 plans starting on 10/1/15 is

straightforward, and can be done in Notes.

Q and A (51:15 – 1:28:36)

1) Set up appropriate ICD-10 codes to correspond to the ICD-9 codes your practice uses

Assess what ICD-9 codes your practice is currently using; then establish your own

mapping of ICD-9 to ICD-10 (equivalents)

a) Advanced Settings – Functional Preferences – Care Plans – ICD-9. You will see your

existing in-house codes, and the ICD-10 equivalents per the preloaded standard

GEMS equivalents (already loaded into the system for you).

b) Remember that the standard GEMS codes bring you to the unspecified version of the

ICD-10 codes. You will need to do further mapping for your ICD-10 GEMS equivalents,

and add additional codes you would like to use. Make sure you have a code book

with you so you can review specifics and rules.

i) Click on an ICD-10 code

ii) Search by ICD-10 code or keyword (add value, then click the magnifying glass to

Search.

iii) Check the box for codes you would like to add to your in-house list

iv) Click the button “Add selected ICD-10 Codes”

v) Review, then click the “Save” button

vi) Check for the success message

vii) Close that window. Note that the system shows you the type (G for standard

GEMS, C for a custom code you add for your practice).

viii) Use your code book to make sure your searches are complete. In the following

example, for GEMS ICD-10 M17.10, an appropriate search is not “M17.1”, but

rather “M17.” because there are other codes you probably need to select. Include

the decimal to efficiently search.

c) Once you are done, make sure you save all your work using the Save button at the

bottom of the Add/Edit Settings screen to save your created custom crosswalk.

2) Validate your equivalents with a test patient record

a) Start by creating a test patient: Add New Patient, enter test information, Save Patient

Data

b) Then, using that test patient, bring up your Care Plans, choose ICD-10, and update

them using your ICD-10 codes.

Choosing ICD-10 will bring up your list of ICD-10 codes, and you choose the

appropriate ICD-10 equivalent (GEM or custom equivalent, set up in Step 1, above) to

add to the care plan, using the Equivalent Selector.

Note: The magnifying glass icon allows you to search the entire list of ICD-10 codes

from this screen, should you require one you did not set up in your equivalents

before.

Also note that “Select Diagnoses” includes the ICD-10 codes you’ve added to your

practice’s list by creation of custom equivalents. If you mapped it in Step 1, you will

have it available throughout the application.

c) Continue through the application and test claims, notes, billing

Notes example:

3) Once you are satisfied with your equivalents, create ICD-10 versions of your care plan

templates and test using your test patient record

a) In Advanced Settings, select Care Plan Templates.

When you click on the Convert icon, the system will bring up the Equivalent Selector

for you to use in converting your care plan templates.

b) When you are Done and click Save, the system will prompt you to rename the

template; it will automatically append “ICD-10” to the end of the care plan template

name as a proposed new name.

You will then see, in your care plan template list, the ICD-10 version you created and

saved.

c) In order to test out your new care plan templates using your test patient record,

create an ICD-10 insurance carrier, and assign that to the test patient. Choose Edit

Patient, then Insurance Details. Make sure you uncheck “Self-Pay”.

i) Go to Carriers tab, and click on the button Add new carrier. Create a new carrier,

set ICD-10 to Yes, and change the default ICD-10 start date from 10/1/15 to

today’s date.

ii) Assign this new carrier to your test patient, and add a test Insured ID Number

iii) You will also want to create a test payer in ICD-9 so you can accurately compare

ICD-9 and ICD-10 results, and test functionality if your practice will be dealing with

both ICD-9 and ICD-10 payers.

Note: You can continue to use these test payers for all your test patients, using

Add Insurance Info.

d) You will now see that when you create a care plan for that patient, the care plan

template list now includes your ICD-9 and ICD-10 templates. You can now test your

ICD-10 templates by creating care plans and notes.

4) If your practice uses the Billing module, you need to update Insurance Carriers to ICD-10

as appropriate.

To do this, go to Advanced Settings, Insurance Carriers. Since some payers are not

converting to ICD-10, you have the ability to specify, per payer, whether ICD-9 or ICD-10

is appropriate. You will see a checkbox for Use ICD10. You can use that checkbox, or you

can go into each insurance carrier record and set ICD-10 and the ICD-10 start date.

Remember, default is 10/1/15. Save your changes.

Go into your test patient, create notes using ICD-10 codes, save and sign. Then you can

test Billing as well. Open the claim that was automatically created when you signed the

note, select Edit, and you can use the same Equivalent Selector to select appropriate

ICD-10 codes.

If you follow these steps, then converting existing patients to ICD-10 on 10/1/15 is straightforward

because you can change them at the note level.